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Endorsements

Please fill out and submit the form below for endorsements to G/L policies.
For endorsement requests for all other coverages, please contact Larissa Avila at lavila@shieldins.net.

* required field
Named Insured: Policy Number:
Name of Business:
Insured Address: City:
State: Zip:
Type of Endorsement:

Cert Holders Details

Is there are a contract?  Yes  No 
First Name: Last Name:
Company:
Address: City:
State: Zip:
Project Location:
Job Description:

Broker Information

First Name: Last Name:
Company:
Address: City:
State: Zip:
Phone: Email:

Shield Commercial Insurance Services, Inc.
43-725 Monterey Ave, Ste A. Palm Desert, CA 92260
Tel: 760-345-9029 Fax: 800-345-4851
CA License Number: 0E67754